Cleaning system for imaging devices

ABSTRACT

An apparatus includes a tubular structure having a proximal end, a distal end, and a body extending between the proximal and distal ends, wherein the body includes a lumen for housing at least a part of an imaging device, and a fluid delivery channel that is fixed in position relative to the body, and an opening that is in fluid communication with the fluid delivery channel, wherein the fluid delivery channel has a first portion, and a second portion that forms an angle with an axis of the first portion.

This application is a divisional application of prior U.S. applicationSer. No. 12/545,690, filed on Aug. 21, 2009, which is incorporatedherein by reference in its entirety.

FIELD

This application relates to a surgical instrument, and moreparticularly, to a surgical instrument for use in a vessel harvestingprocedure.

BACKGROUND

A significant area of cardiovascular disease involves the build up ofplaque inside arteries that feed blood to the muscles of the heart.These deposits can cause occlusions which reduce or interrupt blood flowthrough these arteries. Coronary artery bypass grafting is a surgicalprocedure that has been used to address occlusions by creating analternative blood path that bypasses the occluded artery.

Before a bypass surgery is performed, a vessel needs to be harvestedfrom a patient's body for use as a conduit in the bypass surgery. Inendoscopic vessel harvesting (EVH) surgical procedures, a long slendercannula with a working lumen may be inserted inside a patient, andadvanced into a tunnel next to the saphenous vein in the patient's leg,the radial artery in the patient's arm, or any other targeted vessel forgrafting. A surgical tool housed at least partially within the workinglumen of the cannula may be placed along the saphenous vein to dissectthe vessel away from adjacent tissue, and to sever side-branch vesselsalong the course of the vessel to be harvested. The surgical tool may beconfigured to grasp a vessel, and may include one or more operativeelements for cutting and/or sealing the vessel. While the surgical toolis used to operate on tissue, an endoscope may be used to view theprocedure.

Applicant of the subject application discovers that sometimes during theEVH procedure, blood, fatty tissue, debris, or other bodily substancemay stick onto the lens of the endoscope, and/or may smear the endoscopelens. Thus, applicant of the subject application determines that it maybe desirable to have a cleaning system for cleaning the lens of theendoscope during the EVH procedure, or during any procedure whichrequires the use of an endoscope or other types of imaging device.

SUMMARY

In accordance with some embodiments, an apparatus includes a tubularstructure having a proximal end, a distal end, and a body extendingbetween the proximal and distal ends, wherein the body includes a lumenfor housing at least a part of an imaging device, and a fluid deliverychannel that is fixed in position relative to the body, and an openingthat is in fluid communication with the fluid delivery channel, whereinthe fluid delivery channel has a first portion, and a second portionthat forms an angle with an axis of the first portion.

In accordance with other embodiments, an apparatus includes a tubehaving a proximal end, a distal end, and a body extending between theproximal and distal ends, a lumen located in the body, wherein the lumenhas a first portion that is parallel to a longitudinal axis of the body,and a second portion that forms an angle with the first portion, and anopening at a surface of the body, wherein the opening is in fluidcommunication with the second portion of the lumen.

In accordance with other embodiments, an apparatus includes a shafthaving a proximal end, a distal end, and a body extending between theproximal and distal ends, a lumen in the body, a retractor attached to arod, wherein at least a part of the rod is located within the lumen, andthe retractor is slidable relative to the shaft, wherein the retractorcomprises a first portion and a second portion, the first portion havinga first tip, the second portion having a second tip, and wherein thefirst and second tips are separated from each other to define a spacetherebetween for allowing a vessel to enter therethrough, and whereinthe first and second portions define a region having a firstcross-sectional dimension that is larger than a second cross-sectionaldimension perpendicular to the first cross-sectional dimension.

Other and further aspects and features will be evident from reading thefollowing detailed description of the embodiments, which are intended toillustrate, not limit, the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings illustrate the design and utility of embodiments, in whichsimilar elements are referred to by common reference numerals. Thesedrawings are not necessarily drawn to scale. In order to betterappreciate how the above-recited and other advantages and objects areobtained, a more particular description of the embodiments will berendered, which are illustrated in the accompanying drawings. Thesedrawings depict only typical embodiments and are not therefore to beconsidered limiting of its scope.

FIG. 1 illustrates a surgical instrument having a handle in accordancewith some embodiments;

FIGS. 2A-2D illustrate a tool for cauterizing and cutting tissue inaccordance with some embodiments;

FIG. 2E illustrates a retractor for engaging a vessel in accordance withsome embodiments;

FIG. 3 is a perspective view of another tool for welding and cuttingtissue in accordance with other embodiments, showing the tool having apair of jaws;

FIG. 4A is a perspective cross sectional view of the pair of jaws ofFIG. 3 in accordance with some embodiments;

FIG. 4B is a cross sectional view of the pair of jaws of FIG. 4A,showing the jaws being used to cut a side branch vessel;

FIG. 5 is a partial exploded view of some components of a surgicalinstrument in accordance with some embodiments;

FIG. 6A illustrates components of the handle of FIG. 1 in accordancewith some embodiments;

FIGS. 6B and 6C illustrate the handle of FIG. 1, showing a control beingoperated in different configurations;

FIG. 7 illustrates some components of the handle of FIG. 1 in accordancewith some embodiments;

FIGS. 8 and 9 illustrate additional components of the handle of FIG. 1in accordance with some embodiments;

FIG. 10 illustrates an actuator of the handle of FIG. 1 in accordancewith some embodiments;

FIG. 11 illustrates some components of the actuator of FIG. 10 inaccordance with some embodiments;

FIG. 12 illustrates a surgical instrument having another handle inaccordance with other embodiments;

FIG. 13 illustrates a surgical instrument having another handle inaccordance with other embodiments;

FIG. 14 illustrates some components of the handle of FIG. 13;

FIG. 15 illustrates a surgical instrument having another handle inaccordance with other embodiments;

FIGS. 16A and 16B illustrate a distal end of a surgical instrumenthaving a washing system in accordance with some embodiments;

FIG. 17 illustrates a component of the washing system of FIG. 16 inaccordance with some embodiments;

FIG. 18 illustrates a cross sectional side view of the washing system ofFIG. 16;

FIG. 19 illustrates another washing system in accordance with otherembodiments;

FIG. 20 illustrates another washing system in accordance with otherembodiments;

FIG. 21 illustrates another washing system in accordance with otherembodiments;

FIG. 22 illustrates a technique for forming a distal portion of a tubethat includes a fluid delivery channel;

FIGS. 23 and 24 illustrate a distal end of a surgical instrument havinga washing system in accordance with other embodiments; and

FIG. 25 illustrates a distal end of a surgical instrument having awashing system in accordance with other embodiments.

DETAILED DESCRIPTION

Various embodiments are described hereinafter with reference to thefigures. It should be noted that the figures are not drawn to scale andthat elements of similar structures or functions are represented by likereference numerals throughout the figures. It should also be noted thatthe figures are only intended to facilitate the description of theembodiments. They are not intended as an exhaustive description of theinvention or as a limitation on the scope of the invention. In addition,an illustrated embodiment needs not have all the aspects or advantagesshown. An aspect or an advantage described in conjunction with aparticular embodiment is not necessarily limited to that embodiment andcan be practiced in any other embodiments even if not so illustrated.

FIG. 1 illustrates a surgical instrument 9 in accordance with someembodiments. The surgical instrument 9 includes a handle 11, anelongated body 13 having a proximal end 10 and a distal end 12, and asurgical device 14 located at the distal end 12 of the body 13. As usedin this specification, the term “surgical device” refers to any deviceor component that may be used to operate on tissue (e.g., to treat,manipulate, handle, hold, cut, heat, or energize, etc., tissue). Thesurgical instrument 9 also includes an elongated tube 20 having a lumenfor housing at least a part of the elongated body 13. In someembodiments, the lumen may also house at least a portion of the surgicaldevice 14. As used in this specification, the term “tube” or similarterms (e.g., “tubular structure”) may refer to any device that has atubular configuration, wherein the device may have a unity configuration(e.g., formed as a single structure), or may be an assembly formed fromassembling different components together. Also, as used in thisspecification, the term “lumen” or similar terms (e.g., “bore,”“opening,” etc.) may refer to any space that is defined by anycomponents. For example, a lumen of a tube may refer to any space thatis defined at least partially by the tube, by a component of the tube,or a component/device that is located within the tube.

The elongated tube 20 has a proximal end 22 that is coupled to thehandle 11. The proximal end 10 of the elongated body 13 is coupled tothe handle 11 such that the body 13 (and therefore the surgical device14) is rotatable and translatable relative to the tube 20. The elongatedbody 13 may be rigid, or alternatively, flexible. The handle 11 includesa manual actuator 15 that is coupled to the surgical device 14 (a tool)through linkage (not shown) within a bore of the body 13 for manuallycontrolling an operation of the surgical device 14. The handle 11 andthe actuator 15 may be made from insulative material(s) such as plastic.The details of the handle 11 will be described below.

The surgical instrument 9 is configured to be coupled to an energysource 30 during use. The energy source 30 is configured to deliverradiofrequency energy in some embodiments. In other embodiments, theenergy source 30 is direct current (DC) source configured to deliver DCenergy.

FIG. 2A illustrates the surgical device 14 at the distal end of thesurgical instrument 9 in accordance with some embodiments. The surgicaldevice 14 includes a first electrode 102, a second electrode 104, and acutter 106. The electrodes 102, 104 are fixedly coupled to the distalend of the body 13, and the cutter 106 is slidably mounted to the body13. The cutter 106 is configured to slide in and out of a slot at thedistal tip of the body 13. The first electrode 102 has a loopconfiguration that is formed by a wire. Similarly, the second electrode104 also has a loop configuration that is formed by another wire. Inother embodiments, the electrodes 102, 104 may have other configurations(e.g., shape, size, and form). The first and second electrodes 102, 104function together as a pair of bi-polar electrodes during use. As shownin the figure, the electrodes 102, 104 are spaced apart from each other,thereby defining a space 108 therebetween for accommodating and securinga vessel (e.g., a side-branch vessel). As shown in the figure, theelongated tube 20 may optionally includes an endoscopic lumen 24 forhousing an endoscope 150 during use. The surgical device 14 may betranslated and/or rotated relative to the tube 20 (and hence, relativeto the endoscope) by operating the actuator 15 at the handle 11. In someembodiments, the surgical instrument 9 may further include the endoscope150.

The distal end of the tube 20 may optionally further include a retractor130 that is slidable relative to the elongated tube 20 and the body 13.The retractor 130 is attached to two rods 116 a, 116 b (FIG. 2B). Asshown in the figure, the rods 116 have a curvilinear configuration suchthat when they are deployed out of the lumen of the tube 20, they curveaway from the surgical tool/device 14. In other embodiments, the rods116 may have a rectilinear or other configuration. As shown in thefigure, the tube 20 has a cleaning device 160 for cleaning the lens ofthe endoscope 150 during use. Alternatively, one of the two rods 116 mayhave a fluid delivery lumen for delivering fluid (e.g., saline, water)towards the endoscope 150 for cleaning the lens of the endoscope duringuse.

The handle 11 may further include another actuator that is mechanicallycoupled by linkage (e.g., which may be the rods 116 themselves, or maybe another component, e.g., a shaft, that couples to the two rods 116)housed within the tube 20 for moving the retractor 130 relative to thetube 20. The retractor 130 is configured to engage a main vessel 111during use (FIG. 2B). As used in this specification, the term“retractor” may refer to any device or component that is configured toengage a vessel. Thus, the term “retractor” should not be limited to anyparticular device or component that retracts or moves in a certain way.In some embodiments, the retractor 130 may be considered to be a part ofthe surgical device/tool 14 at the distal end of the surgical instrument9. As shown in FIG. 2E, the retractor 130 includes a first portion 132with a first tip 136, and a second portion 134 with a second tip 138.

The tips 136, 138 define a space 140 therebetween for allowing a vesselto enter therethrough. The first and second portions 132, 134 define aspace 141 for accommodating the vessel once the vessel enters throughthe opening 140. In the illustrated embodiments, the space 141 has adimension 142 that is longer to another dimension 144 perpendicular tothe dimension 142. The space 141 has an elliptical shape. In otherembodiments, the space 141 may have other shapes, such as a circularshape.

As shown in FIG. 2B, the electrodes 102, 104 may be configured (e.g.,size, shaped, spaced apart by a certain distance, etc.) to capture avessel 110 (e.g., a side branch vessel), while the retractor 130 engageswith the main branch vessel 111. The cutter 106 is omitted in FIG. 2Bfor clarity purpose. The electrode 104 has a ramp portion 114 thatallows the vessel 110 to be easily captured at the space 108. When thevessel 110 is captured between the electrodes 102, 104, energy may bedelivered from an energy source 30 to the electrodes 102, 104, whichfunction as bi-polar electrodes to deliver RF energy, thereby heatingthe vessel. The vessel may be heated to a temperature that welds/sealsthe vessel. When the vessel 110 is sealed, the actuator 15 at the handle11 may be operated to slidably move the cutter 106 relative to theelectrodes 102, 104 from a first position (FIG. 2C) to a second position(in the direction shown) to thereby cut the sealed vessel 110 (FIG. 2D).Such may be accomplished by providing a mechanical linkage housed withinthe body 13, which couples the actuator 15 to the cutter 106. As shownin the figures, the body 13 may include a protrusion at the interiorwall that functions as a deflector 152 for causing the cutter 106 tomove downward when a top portion 154 of the cutter 106 engages with thedeflector 152.

It should be noted that the tool at the distal end of the surgicalinstrument 9 is not limited to the example shown in FIG. 2, and that thesurgical instrument 9 may include other tools having differentconfigurations in other embodiments. FIG. 3 illustrates another surgicaldevice 14 at the distal end of the surgical instrument 9 in accordancewith other embodiments. In the illustrated embodiments, the surgicaldevice 14 is a jaw assembly that includes a pair of jaws 321, 323 forclamping, cutting, and sealing a vessel. The jaw 321 includes anelectrically conductive material 325 which faces towards the opposingjaw 323. Alternatively, or additionally, the jaw 323 may include anelectrically conductive material which faces towards jaw 321. Theelectrically conductive material 325 is in a form of an electrode, andis configured to provide heat during use. As used in this specification,the term “electrode” refers to a component that is for deliveringenergy, such as heat energy, RF energy, etc., and thus, should not belimited to a component that delivers any particular form of energy. Theelectrically conductive material 325 may be Ni-chrome, stainless steel,or other metals or alloys in different embodiments. The jaws 321, 323are configured to close in response to actuation (e.g., pressing,pulling, or pushing, etc.) of the actuator 15, thereby clamping a vesselduring use. In the illustrated embodiments, the actuator 15 may befurther actuated (e.g., further pressed, further pulled, or furtherpushed, etc.) to cause the electrically conductive material 325 toprovide heat, thereby cutting and sealing the clamped vessel. Inparticular, when the actuator 15 is further actuated, the electricallyconductive material 325 is electrically coupled to an energy source 30(e.g., a DC source), which provides a current to the electricallyconductive material (electrode) 325, thereby heating the electrode 325.After the vessel is cut and sealed, the actuator 15 may be de-actuatedto open the jaws 321, 323, thereby stopping the delivery of heat. Themechanical linkage for translating operation of the actuator 15 intoclosing and opening of the jaws 321, 323 may be implemented usingcables, shafts, gears, or any of other mechanical devices that are knownin the art. In other embodiments, a separate actuator (either on thehandle 11 or otherwise coupled to the source 30, such as a separate footpedal, etc.), may be provided for directing energy from the energysource 30 to the electrode 325. In such cases, the actuator 15 is forclosing and opening the jaw assembly, and is not used to cause theenergy source 30 to deliver energy to the electrode 325.

The linkage that mechanically couples the jaws 321, 323 to the actuator15 may be electrically insulated, for example, by silicone rubber,ceramic or other suitable non-electrically conductive material. In someembodiments, energy is supplied from the energy source 30 via electricline housed by the body 13 to the electrically conductive material(electrode) 325 at jaw 321 (and/or electrode at jaw 323). In otherembodiments, the body 13 may not include an electric line for deliveringenergy to the electrode 325. Instead, the linkage that mechanicallycouples the jaws 321, 323 to the actuator 15 may be electricallyconductive, and is used to deliver energy to the electrode 325 at jaw321 (and/or electrode at jaw 323).

As shown in the figure, the electrically conductive material 325 forms aheating element (electrode) 340 that is disposed on a surface of the jaw321. The heater element 340 includes two outer portions 350, 352, and aninner (middle) portion 348. The outer portions 350, 352 have respectiveouter terminals 344, 346 at their ends, and the middle portion 348 hasan inner terminal 342 at its end. Thus, the portions 348, 350, 352 forman electrical heater circuit between the center terminal 342 and outerterminals 344, 346. In the illustrated embodiments, the outer portions350, 352 and the inner portion 348 function as an electrode that isconfigured to deliver heat during operation. In particular, duringoperation, the terminal 342 of the electrode 340 is electrically coupledto a first terminal of the DC source 30, and terminals 344, 346 of theelectrode 340 are electrically coupled to a second terminal of the DCsource 30, thereby allowing the electrode 340 to receive DC energy(e.g., for cutting and/or welding tissue). The heating element 340 maybe formed using a single, flat sheet of electrically conductive material(e.g., Ni-chrome alloy, such as stainless steel at an outer layer, andNi-chrome at an inner layer). This has reliability, manufacturing andcost advantages. It also reduces the likelihood of tissue build up andentrapment during use by not creating crevices into which the tissue canmigrate.

As shown in FIG. 3, the jaw-operating mechanism and linkage thereof maybe supported in a metal housing 368 that includes metal sliding pin 370and attachment pin 372, all covered with an insulating layer of flexiblematerial such as silicone rubber, or the like, to restrict energydischarges and to isolate tissue from moving parts. Also, suchinsulating cover retains the sliding and attachment pins 370, 372 inplace to obviate the need for more expensive fasteners and mechanisms.

During use, current from the DC source 30 is conducted through thecenter terminal 342, and flows in the middle portion 348 of the heaterelement 340 and in parallel through the dual outer portions 350, 352 ofthe heating element 340 to the common terminals 344, 346. Thus, forheater portions 348, 350, 352 of equal thicknesses and equal widths,current density in the middle portion 348 is twice as high as thecurrent density in each of the outer portions 350, 352 in response toelectrical heater signal applied between terminal 342 and the commonterminals 344, 346. Of course, current densities in the center and outerportions 348, 350, 352 may be altered (for example, by altering therelative widths of the heater portions, by altering resistances throughselection of different materials, by altering both the widths andresistances, etc.) to alter the operating temperatures thereof inresponse to applied electrical heater signals. In operation, the outerheater portions 350, 352 may operate at a temperature sufficient to welda tissue structure (e.g., a blood vessel) grasped between the jaws 321,323, and the center heater portion 348 may operate at a highertemperature sufficient to sever the grasped tissue structureintermediate the welded segments.

Referring now to FIG. 4A, there is shown a partial cross sectionalperspective view of the jaws 321, 323 that illustrates the placement ofheater portions 348, 350, 352. The jaw 321 includes a structural support364, and the jaw 323 includes a structural support 366. The supports364, 366 may be made from any materials, such as ceramic, polymers,stainless steel, or other metals or alloys. In some embodiments, thestructural supports 364, 366 may be made from electrically conductivematerial that allows the supports 364, 366 to function as electricallines (e.g., for transmitting current, RF signal, etc.). The structuralsupports 364, 366 are covered by respective layers 374, 376 ofelectrically insulating material, such as rubber, polymers, silicone,polycarbonate, ceramic or other suitable insulating material. Thestructural supports 364, 366 may include opening(s) 378, 380 along thelength of the respective supports 364, 366 (FIG. 4B). This allows thelayers 374, 376 to be overmolded onto the respective supports 364, 366without using any adhesive to secure the layers 374, 376 relative to therespective supports 364, 366. In particular, as the layers 374, 376 aremolded over the respective supports 364, 366, the molding material willflow through the openings 378, 380, thereby mechanically anchoring thelayers 374, 376 relative to the respective supports 364, 366. As shownin the figure, the jaw 323 includes a surface elevation (protrusion) 354substantially in alignment with the middle portion 348 in order toincrease the compression force applied to a tissue structure grasped bythe jaws 321, 323 and in contact with the middle portion 348. Thispromotes more efficient tissue severance, while adjacent regions 356,358 of lower surface elevations on jaw 323 in alignment with the outerportions 350, 352 of the heater element introduce less compression forcesuitable for welding grasped tissue.

In the illustrated embodiments, the cross sections of the respectivejaws 321, 323 are not symmetrical. Instead, jaw 321 has a protrusion360, and jaw 323 has a protrusion 362. Each of the protrusions 360, 362has a length so that when the protrusions 360, 362 abut against a mainbranch vessel MB, the cutting point of the side branch vessel SB is at aprescribed distance D that is spaced away from the main branch vessel MB(FIG. 4B). In the illustrated embodiments, the distance D is at least 1mm, and more preferably, at least 1.5 mm. In other embodiments, thedistance D may have other values, such as that which is sufficient toprevent or minimize thermal spread from electrode 340 to the main branchvessel MB being harvested. As illustrated in the embodiments, theprotrusions 360, 362 are advantageous in that they help reduce thermalspread resulting from the cutting and sealing of the side branch vesselSB, thereby preserving the integrity of the main branch vessel MB thatis being harvested. Also, the protrusions 360, 362 obviate the need foran operator to guess whether the cutting of the side branch vessel SB issufficiently far (e.g., beyond a minimum prescribed spacing) from themain branch vessel MB. Instead, the operator merely abuts theprotrusions 360, 362 of the jaw assembly against the main branch vesselMB, and the protrusions 360, 362 will automatically place the jawassembly relative to the side branch vessel SB so that the side branchvessel SB is cut at a minimum prescribed distance D from the main branchvessel MB. In some cases, if the surgical instrument 9 is used to cutother types of tissue, such as nerves, organs, tendons, etc., theprotrusions 360, 362 also provide the same benefits of preserving theintegrity of tissue that is being cut, and obviating the need for a userto guess what is the appropriate margin. As shown in the figure, theprotrusions 360, 362 diverge away from part of the side branch vesselSB. Such configuration allows part of the side branch vessel SB that isimmediately next to the main branch vessel MB not to be clamped by thejaws. As a result, the end of the side branch vessel SB will fall awayonce it is cut. In other embodiments, the surgical instrument 9 does notneed to include both protrusions 360, 362. Instead, the surgicalinstrument 9 may include either protrusion 360 or protrusion 362. Suchconfiguration allows the device at the distal end of the instrument 9 tohave a smaller profile, thereby allowing a user to effectively maneuverthe distal device in tight tissue conditions.

As shown in the figure, the heater portion 352 may protrude laterallyalong an outer edge of the closed jaws 321, 323. Such configuration mayallow the heater portion 352 to deliver energy from the side of the jawassembly even when the jaw assembly is closed. This may allow the heaterportion 352 to heat tissue from a side of the jaw assembly during anoperation, such as, for bleeding control. In other embodiments, the jawsmay not include the protrusions 360, 362.

As shown in FIG. 3, the jaw assembly has a concave side and a convexside. In one method of use, while the jaw assembly is used to cut a sidebranch vessel SB, the jaw assembly is oriented so that its concave sidefaces towards the main branch vessel MB. The endoscope or viewing devicemay be placed next to the jaw assembly with the endoscope or viewingdevice viewing the concave side of the jaw assembly. This allows theuser to better visualize the tip of the jaw assembly. Such configurationalso provides a safety feature by allowing the user to know where thetips are during the vessel cutting procedure. Also as shown in FIG. 3,the exposed electrode portion 352 is on the convex side of the jawassembly while the protrusions 360, 362 are on the concave side of thejaw assembly. The concavity provides extra spacing to protect the mainbranch vessel MB by keeping the distance along the side branch vessel SBeven greater when it is grasped. Furthermore, having the exposedelectrode 352 on the convex side creates an apex point that makes iteasier to contact the side wall of the tunnel to address bleeding. Inother embodiments, the protrusions 360, 362 may be on the convex side ofthe jaw assembly. In such cases, during use, the convex side of the jawassembly would be oriented towards the main branch vessel MB, therebyensuring that the tips of the jaw assembly are away from the main branchvessel MB to enhance protection (e.g., preventing the tip of the jawassembly from touching or injuring the main branch vessel MB).

Referring now to FIG. 5, there is illustrated an exploded view showingsome components of the surgical instrument 9. Specifically, the heaterelements 348, 350, 352 (conductive material 325) are attached to jaw321. Both jaws 321, 323 are pivotally attached via pin 377 to the metalhousing 368. Pin 370 is disposed to slide within the aligned slots 379,and within the mating angled slots 381, 383 in the frame-mounts of theassociated jaws to effect scissor-like jaw movement between open andclosed positions as the slide pin 370 is moved relative to the pivot pin377. Actuator rod 336 is linked to the slide pin 370, for example, viayoke 399. In the illustrated embodiments, the proximal end of the rod336 is mechanically coupled to the actuator 15 at the handle 11. Axialmovement of the rod 336 in one direction will cause the slide pin 370 tomove towards the pin 377, thereby opening the jaws 321, 323. Axialmovement of the rod 336 in the opposite direction will cause the slidepin 370 to move away from the pin 377, thereby closing the jaws 321,323. An electrical conductor 389 connects to the inner terminal 342 ofthe heating element 348, 350, 352, and the outer terminals 344, 346 areelectrically connected in common to conductor 391. In some embodiments,either conductor 389 or 391 may be housed within the wall or the bore ofthe elongated body 13. In other embodiments, if the rod 336 iselectrically conductive, either conductor 389 or 391 may be coupled tothe rod 336. In such cases, the rod 336 will be electrically coupled toone terminal of the DC source 30 during use. During use, the conductors389, 391 may be electrically coupled to terminals of the DC source 30,which provides a current to thereby heat up the heater elements 348,350, 352. The center heater element 348 is configured to cut a vessel(e.g., a side branch vessel) while the outer heater elements 350, 352are configured to weld (seal) the vessel. In some embodiments, parts ofthe surgical device 14 may be insulated via an outer insulating layerfor isolating certain components from biologic tissue and fluids.

In any of the embodiments described herein, the jaw assembly at thedistal end of the surgical instrument 9 does not need to include all ofthe features described herein. For example, in some embodiments, the jawassembly does not include outer electrode portions 350, 352. Instead,the jaw assembly includes one electrode strip (like the middle electrodeportion 348 described above) for cutting or sealing tissue. Furthermore,in other embodiments, the jaw 323 may not have the raised portion 354.Instead, the jaw 323 may have a flat surface that is for contacting theelectrode portions 348, 350, 352. In addition, in further embodiments,the jaws 321, 323 may not include the respective protrusions 360, 362.Instead, the cross section of the jaw 321/23 may have a symmetricalconfiguration. In other embodiments, protrusion(s) may be provided onboth sides of the jaw assembly (e.g., one or more protrusions at theconcave side of the jaw assembly, and one or more protrusions at theconvex side of the jaw assembly). Such configuration provides bufferingon both sides of the jaw assembly, and allows for correct placement ofthe jaw assembly regardless of which side (the concave or convex side)of the jaw assembly is oriented towards the main branch vessel MB duringuse. In further embodiments, instead of the curved configuration, thejaws could be straight. Also, in any of the embodiments describedherein, instead of, or in addition to, using the jaw assembly forcutting and/or welding of vessel tissue, the jaw assembly may be usedfor transection of other types of tissue, such as fatty and connectivetissue encountered during a vessel harvesting procedure or otherprocedures.

FIG. 6A illustrates the handle 11 of the surgical instrument 9 of FIG. 1in accordance with some embodiments. The handle 11 includes a supportportion 400, a carriage 402 slidably mounted to the support portion 400,the actuator 15, and a coupler 404 for coupling the actuator 15 to thecarriage 402. As used in this specification, the term “support portion”may refer to any part of a handle, relative to which the carriage 402 orthe actuator 15 may move, and does not need to provide any particularform of support for the remaining components of the handle. Thus, theterm “support portion” should not be limited to a base or any otherparts of the handle. During use, the actuator 15 may be moved by afinger (e.g., thumb, index finger, etc.) laterally as indicated by thearrow shown. Movement of the actuator 15 moves the coupler 404 relativeto the carriage 402, thereby rotating the body 13 (and hence, thesurgical device/tool 14) relative to the tube 20.

For example, the actuator 15 may be moved laterally towards the rightside (FIG. 6B), thereby rotating the coupler 404 about an axis that isparallel to the longitudinal axis of the handle 11. Rotation of thecoupler 404 relative to the carriage 402 actuates a gear system at thecarriage 402, thereby turning the body 13 (and hence, the surgicaldevice/tool 14) relative to the tube 20 in the same direction as therotation of the coupler 404. During use, either the actuator 15 or thecoupler 404 may be operated by the user's finger to rotate the tube 20.

Similarly, the actuator 15 may be moved laterally towards the left side(FIG. 6C), thereby rotating the coupler 404 about an axis that isparallel to the longitudinal axis of the handle 11. Such rotation of thecoupler 404 relative to the carriage 402 actuates a gear system at thecarriage 402, thereby turning the body 13 (and hence, the surgicaldevice/tool 14) relative to the tube 20 in the same direction as therotation of the coupler 404. During use, either the actuator 15 or thecoupler 404 may be operated by the user's finger to rotate the tube 20.

FIGS. 7-11 illustrate some components of the handle 11. As shown in FIG.7, the handle 11 includes a gear system 410 having a first gear 412 anda second gear 414 mounted between a first carriage portion 420 and asecond carriage portion 422, wherein the first and second carriageportions 420, 422 together form the carriage 402. The first gear 412includes a small gear 423 and a large gear 424, and is rotatably mountedto the carriage 402. The small gear 423 and the large gear 424 arefixedly secured to each other. The second gear 414 is also rotatablymounted to the carriage 402, and engages with the small gear 423. Thecarriage 402 includes an opening 430 for allowing a part of the largegear 424 to be accessed. As shown in the figure, a gear 440 is fixedlysecured to the proximal end 10 of the body 13. The proximal end 10 withthe gear 440 extends through an opening 442 at the carriage 402, therebyallowing the gear 440 to be engaged with the second gear 414. Also, asshown in the figure, wires that are connected to the electrodes 102, 104(in the embodiments of FIG. 2) or to terminals at the electrode 325 (inthe embodiments of FIG. 3) may be housed in a cable 441, which extendsout of the body 13 and through a central opening at the gear 440. Insome embodiments, the wires may be coupled to the energy source 30. Inother embodiments, if the handle 11 is also used to deliver energy tothe surgical device/tool 14, then at least one of the wires may beconnected to a switch located in the handle 11.

As shown in FIGS. 8 and 9, the coupler 404 includes a first couplerportion 450 and a second coupler portion 452, which are secured to eachother via two screws 454, 456. The coupler 404 also includes aprotrusion 458, which is configured (e.g., sized and shaped) to engagewith a slot 459 at the carriage 402. The slot 459 guides the motion ofthe coupler 404 so that the coupler 404 will move relative to thecarriage 402 in a defined path (e.g., in a curvilinear path). Thecoupler 404 also includes a ring gear 460, which is configured to engagewith the large gear 424 at the opening 430 of the carriage 402. Althoughthe actuator 15 and the coupler 404 have been described as separatecomponents, in other embodiments, the coupler 404, or any of itscomponents, may be considered to be a part of the actuator 15. Also,although the carriage 402 and the coupler 404 have been described asseparate components, in other embodiments, the coupler 404, or any ofits components, may be considered to be a part of the carriage 402.

Also, as shown in the figures, the actuator 15 includes a surface 471for allowing manipulation of the actuator 15 by a finger, andprotrusions 470, 472 for preventing the finger from sliding off the edgeof the actuator 15 during use. During use, the actuator 15 may be movedlaterally towards the right side (such as that shown in FIG. 6B) to pushthe coupler 404 to rotate relative to the carriage 402 in the directionof actuation. The rotation of the coupler 404 relative to the carriage402 causes the ring gear 460 to move relative to the carriage 402,thereby turning the large gear 424 at the opening 130. Since the largegear 424 is fixedly secured to the small gear 423, rotation of the largegear 424 will rotate the small gear 423 in the same direction as that ofthe large gear 424. Rotation of the small gear 423 turns the second gear414, which in turn, rotates the gear 440 at the proximal end 10 of thebody 13. Thus, the second gear 414 is for causing the body 13 and thesurgical device 14 to rotate in the same direction as that of theactuator 15. Also, during use, the actuator 15 may be moved laterallytowards the left side (such as that shown in FIG. 6C) to push thecoupler 404 to rotate relative to the carriage 402 in the direction ofactuation. This will result in the body 13 rotating in the samedirection as the direction of actuation, as similarly discussed.

In some embodiments, the gear system may be configured (e.g., byselecting a desired gear ratio, gear size, number of gears, etc.) suchthat a relatively small amount of movement by the actuator 15 willresult in a rotation of the body 13 and the surgical device 14 through alarge angular range. For example, in some embodiments, a rotation of theactuator 15 through an angular range of ±40° or less will result inturning of the body 13 and the surgical device 14 by ±180° or more of40°. Thus, by moving the actuator 15 from the left-most position to theright-most position (or vice versa), the body 13 and the surgical device14 may be turned 360°. Such configuration is beneficial in that itachieves amplification of motion for the body 13, thereby allowing thebody 13 and the surgical device 14 to be rotated relative to the handle11 efficiently. In should be understood that during use of the surgicalinstrument 9, the body 13 does not always need to be rotated 360°. Forexample, a user may want to rotate the body 13 and the surgical device14 by an angle θ_(t) that is less than 360°. In such cases, the user mayrotate the actuator 15 by an angle θ_(c) to a desired position asdetermined by the user, thereby rotating the body 13 and the surgicaldevice 14 by a desired angular range θ_(t). As discussed, θ_(t) islarger than θ_(c). In some embodiments, the gear system may beconfigured such that a movement by the actuator 15 will result in arelatively smaller rotation of the body 13 and of the surgical device14, for finer control of angular position. In such cases, θ_(t) is lessthan θ_(c). In some embodiments, θ_(t) and θ_(c) may be governed by therelationship: θ_(t)=k θ_(c), wherein k represents an amplificationfactor when k>1, and represents a reduction factor when k<1. In somecases, k is a constant that is based on the design of the gear system.

In the illustrated embodiments, the actuator 15 is slidably coupled to abase 500 (FIG. 10). The base 500 has projections 480, 482 on either sideof the base 500 for engagement with respective slots 484, 486 at thecoupler 404 (see FIGS. 9-11). The actuator 15 is also rotatably coupledto an arm 476 via the shaft 490. In particular, the shaft 490 is housedwithin a slot formed by a first actuator portion 502 and a secondactuator portion 504 (FIG. 11). The shaft 490 allows the arm 476 to bepivotable relative to the actuator 15 in the direction shown in FIG. 10.Such tilting motion allows the actuator 15 to be moved laterally (as inFIG. 6B or 6C) along an arc-path with a center that is offset from alongitudinal axis of the body 13. In other embodiments, if the arc-pathof the actuator's 15 movement has a center that coincides with alongitudinal axis of the body 13, then the tilting of the arm 476relative to the actuator 15 is not required. The actuator portion 504has a slot 506 for slidable engagement with a protrusion 512 at the base500. Similarly, the actuator portion 502 has a slot (with the sameconfiguration as that of slot 506) for slidable engagement with aprotrusion 510 at the base 500. The arm 476 has a socket 478 at its endfor mating with a sphere 448 at an end of a rod 446 that extends out ofthe body 13. In some embodiments, the rod 446 may be coupled to thecutter 106 in the embodiment of FIG. 2 for actuating movement of thecutter 106. In other embodiments, the rod 446 may be the shaft 336 inthe embodiment of FIG. 5 for actuating movement of the jaw assembly. Thesocket 478 together with the sphere 448 forms a ball joint that allowsthe arm 476 to move in different degrees of freedom with respect to therod 446. In any of the embodiments described herein the arm 476 and/orthe base 500 may be considered to be a part of the actuator 15. In otherembodiments, the arm 476 and/or the base 500 may be considered to be apart of the coupler 404.

When the surface 471 of the actuator 15 is pressed down towards the base500, the slidable engagement between the slot 506 and the protrusion 512at the base 500 will guide the actuator 15 to move in a curvilinear path(defined by the shape of the slot 506). In the illustrated embodiments,the pressing of the surface 471 of the actuator 15 will cause theactuator 15 to move proximally relative to the base 500. This in turncauses the bottom end of the arm 476 to move proximally to pull the balljoint, thereby pulling the rod 446 backward. This in turn pulls thecutter 106 at the distal end of the surgical instrument 9 proximally.Alternatively, in the case of the embodiment of FIG. 5, this will inturn pull the rod 336 proximally to close the jaw assembly. After thesurface 471 is pressed down, the rear surface 520 of the actuator 15will be moved to a higher elevation. The user may press the rear surface520 downward against the base 500 so that the actuator 15 is slidablymoved distally relative to the base 500, as governed by the slidableengagement between the slot 506 and the protrusion 512. This in turncauses the bottom end of the arm 476 to move distally to push the balljoint, thereby pushing the rod 446 distally. This in turn pushes thecutter 106 at the distal end of the surgical instrument 9 distally.Alternatively, in the case of the embodiment of FIG. 5, this will inturn push the rod 336 distally to open the jaw assembly.

Also, during use, the actuator 15 (or the coupler 404) may be pusheddistally so that the carriage 402 together with the body 13 and thesurgical device 14 is translated distally relative to the tube 20.Alternatively, the actuator 15 (or the coupler 404) may be pulledproximally so that the carriage 402 together with the body 13 and thesurgical device 14 is translated proximally relative to the tube 20.

In some embodiments, the handle 11 may further includes an electricalcontact, such that when the actuator 15 is further pulled proximally,the electrical contact will close a conductive path, thereby allowing acurrent to be delivered from the energy source 30 to the electrodes 102,104, or to the electrode 325 at the jaw assembly. For example, the cable441 may carry a first wire connected to a first terminal at theelectrode 325, and a second wire connected to a second terminal at theelectrode 325. At the proximal end, the first wire may be electricallyconnected to the electrical contact at the actuator 15, and a receivingcontact (not shown) in the handle 11 may be coupled to a first terminalat the energy source 30. Also, at the proximal end, the second wire maybe coupled to a second terminal at the energy source 30. During use, theactuator 15 may be pulled all the way to the back to engage theelectrical contact at the actuator 15 with the receiving contact,thereby closing a conductive path formed by the energy source 30, theelectrode 325, and the first and second wires, and allowing energy to bedelivered from the energy source 30 to the electrode 325. In otherembodiments, the actuator 15 is not configured to cause delivery ofenergy from the energy source 30 to the electrodes 102, 104, or to theelectrode 325.

As illustrated in the above embodiments, the handle 11 is advantageousin that it allows rotation and/or translation of the body 13 (and hence,the surgical device 14) relative to the tube 20, and movement of acomponent of the surgical device 14, to be accomplished by manipulationof a single actuator 15. In some embodiments, the control may beconfigured to be operated like a joystick so that it can be used torotate the tool 14 (e.g. by moving the control left or right) andtranslate the tool 14 (e.g., by moving the control forward or backward),wherein the translation of the tool 14 may be done simultanesoulsy orseparately from the rotation of the tool 14. Such joystick like controlmay also allow actuation of a component (e.g., a cutting element, a jaw,an electrode, etc.) of the tool 14 (e.g. by providing a pivitable ordepressable control surface, such as a button). In some cases, theactuator 15 also allows delivery of energy from the energy source 30 tothe surgical device 14. The handle 11 is also advantageous in that itrotates the surgical device 14 by a large angular amount in response toa relatively small movement of the actuator 15, thereby providingamplification of movement of the surgical device 14.

During use of the surgical instrument 9 to harvest a vessel, the tube 20is inserted into the patient's body through an opening (e.g., anincision through the patient's skin). The endoscope 150 may be placedinside the tube 20 for viewing at distal end while a surgical procedureis being performed by the surgical device 14. In some cases, theendoscope 150 may optionally include a light source and/or fiber opticsfor illuminating the target site. The distal end of the tube 20 isplaced next to a vessel that is desired to be harvested, such that thelongitudinal axis of the tube is approximately parallel to the vessel.The retractor 130 is then deployed to engage and capture the vessel. Thetube 20 is then advanced distal along the length of the vessel. When aside branch vessel is encountered, the user may then operate the handle11 to deploy the surgical device 14 for cutting and/or sealing the sidebranch vessel. In particular, various components (e.g., the actuator 15and/or the coupler 404) of the handle 11 may be operated to translatethe surgical device 14 proximally or distally relative to the tube 20(as described herein), and/or to rotate the surgical device 14 relativeto the tube 20 (as described herein), thereby placing the surgicaldevice 14 at an operative position relative to the side branch vesselfor operation on the side branch vessel.

The handle 14 may then be further used to cause the surgical device 14to cut and/or seal the side branch vessel. For example, for theembodiments of FIG. 2, the actuator 15, or another actuator on thehandle 11, or a control at the energy source 30, may be operated tocause energy to be delivered to the electrodes 102, 104, thereby heatingthe side branch vessel, and sealing it. The actuator 15 may then beoperated (or further operated) to pull the cutter 106 proximally to cutthe sealed vessel, as described herein. For the embodiments of FIG. 3,the actuator 15 may be operated to close the jaws 321, 323 to grasp andcompress the side branch vessel. Power is then supplied using the DCsource 30 to the heater elements 48, 50, 52 (which function as resistiveelement that heats up in response to the delivered direct current) toeffect tissue welds at tissues that are in contact with outer segments50, 52, and to effect tissue cutting at tissue that is in contact withsegment 48.

FIG. 12 illustrates another handle 11 in accordance with otherembodiments. In the illustrated embodiments, the handle 11 is similar tothe embodiments described previously, except that the coupler 404 isconfigured to move laterally to control a rotation of the surgicaldevice/tool 14 independent of the actuator 15. In such cases, theactuator 15 and/or the coupler 404 is for translating the surgicaldevice/tool 14 longitudinally relatively to the tube 20. The actuator 15may also be used for moving a component (such as the cutter 106, the jawmembers, etc.) of the surgical device/tool 14, as similarly discussed.However, unlike the embodiments of FIGS. 6-11, the actuator 15 cannot beused to rotate the surgical device 14 relative to the tube 20. Instead,rotation of the surgical device 14 relative to the tube 20 is performedby moving the coupler 404 in either direction shown in the figure. Thehandle 11 of FIG. 12 has components that are the same as those in theprevious embodiments, except that the actuator 15 is not configured tomove laterally with the coupler 404. Thus, in the illustratedembodiments, the actuator 15 may be coupled to a base (e.g., base 500)that is fixedly secured to the carriage 402.

FIG. 13 illustrates another handle 11 in accordance with otherembodiments. The handle 11 includes a ring 600 located distal to theactuator 15 for rotating the body 13 (and hence the surgical device/tool14). The ring 600 is circumferentially disposed at the handle 11 so thatit may be conveniently manipulated by one or more fingers of a user. Inthe illustrated embodiments, the operation of the ring 600 isindependent from the operation of the actuator 15. Thus, the actuator 15and/or the coupler 404 may be used to translate the body 13 distally orproximally relative to the tube 20 without involving the ring 600. Theactuator 15 may also be used to move a component (e.g., the cutter 106,the jaws, etc.) of the surgical device/tool 14 without involving thering 600. Also, the ring 600 may be used to rotate the body 13 withoutinvolving the actuator 15 and the coupler 404.

FIG. 14 illustrates some components of the handle 11 of FIG. 13 inaccordance with some embodiments. In the illustrated embodiments, thehandle 11 includes many components that are the same as those of FIGS.6-11. However, unlike the previous embodiments, the handle 11 does notinclude the carriage 402, and the coupler 404 is not rotatably coupledto the carriage 402. Instead, the coupler 404 is slidably coupled to thesupport 400. This allows the body 13 and the surgical device 14 to betranslated relative to the body 20 by translational movement of thecoupler 404 (or the actuator 15) relative to the support 400. The handle11 also includes the gear system 410 having the gears 412, 414. However,unlike the previous embodiments of FIG. 6, the gear system 410 is notcoupled to the moveable carriage 402. Instead, the gear system 410 iscoupled to a portion of the handle 11 that is fixed relative to thesupport 400. As shown in the figure, the ring 600 has a ring gear 602located circumferentially at an interior surface of the ring 600. Thering gear 602 is configured to engage with the gear 412 during use. Thebody 13 has a non-circular cross section (such as a square section) sothat it can transmit rotation from the gear train to the tool, as wellas allow sliding of the tool back and forth. In other embodiments, thebody 13 can have other cross sectional shapes.

In some embodiments, the gear system 410 may be configured (e.g., byselecting a desired gear ratio, gear size, number of gears, etc.) suchthat a relatively small amount of movement by the ring 600 will resultin a rotation of the body 13 through a large angular range. For example,in some embodiments, a rotation of the ring 600 through an angular rangeof ±40° or less will result in turning of the body 13 by ±180° or more.Thus, by turning the ring 600 over a small angular range, the body 13may be turned 360°. Such configuration is beneficial in that it achievesamplification of motion for the body 13, thereby allowing the body 13 tobe rotated relative to the handle 11 efficiently. In should beunderstood that during use of the surgical instrument 9, the body 13does not always need to be rotated 360°. For example, a user may want torotate the body 13 by an angle θ_(t) that is less than 360°. In suchcases, the user may rotate the ring 600 by an angle θ_(c) to a desiredposition as determined by the user, thereby rotating the body 13 by adesired angular range θ_(t). As discussed, θ_(t) is larger than θ_(c).In some embodiments, the gear system may be configured such that amovement by the actuator 15 will result in a relatively smaller rotationof the body 13 and of the surgical device 14, for finer control ofangular position. In such cases, θ_(t) is less than θ_(c). In someembodiments, θ_(t) and θ_(c) may be governed by the relationship:θ_(t)=kθ_(c), wherein k represents an amplification factor when k>1, andrepresents a reduction factor when k<1. In some cases, k may be aconstant that is based on the design of the gear system.

FIG. 15 illustrates another handle 11 in accordance with otherembodiments. The handle 11 includes a plurality of wheels 700 located ata periphery of the handle 11. The wheels 700 are rotatably coupled tothe carriage 702 through the gear system 410 that is housed inside thecarriage 702. In the illustrated embodiments, the handle 11 is similarto the embodiments of FIG. 6, except that it doesn't have the coupler404, and rotation of the body 13 is not controlled by the actuator 15.In such cases, the actuator 15 and/or the wheels 700 may be pusheddistally or pulled proximally for translating the surgical device/tool14 longitudinally relatively to the tube 20. The actuator 15 may also beused for moving a component (such as the cutter 106, the jaw members,etc.) of the surgical device/tool 14, as similarly discussed. However,unlike the embodiments of FIGS. 6-11, the actuator 15 cannot be used torotate the surgical device 14 relative to the tube 20. Instead, rotationof the surgical device 14 relative to the tube 20 is performed byturning any one of the wheels 700. The handle 11 of FIG. 15 hascomponents that are the same as those in the previous embodiments,except that the handle does not include the coupler 404, and theactuator 15 is not configured to move laterally. Thus, in theillustrated embodiments, the actuator 15 may be coupled to a base (e.g.,base 500) that is fixedly secured to the carriage 402.

In some embodiments, the gear system 410 may be configured (e.g., byselecting a desired gear ratio, gear size, number of gears, etc.) suchthat a relatively small amount of movement by any one of the wheels 700will result in a rotation of the body 13 through a large angular range.For example, in some embodiments, a rotation of the wheel 700 through anangular range of ±40° or less will result in turning of the body 13 by±180° or more. Thus, by turning the wheel 700 over a small angularrange, the body 13 may be turned 360°. Such configuration is beneficialin that it achieves amplification of motion for the body 13, therebyallowing the body 13 to be rotated relative to the handle 11efficiently. In should be understood that during use of the surgicalinstrument 9, the body 13 does not always need to be rotated 360°. Forexample, a user may want to rotate the body 13 by an angle θ_(t) that isless than 360°. In such cases, the user may rotate the wheel 700 by anangle θ_(c) to a desired position as determined by the user, therebyrotating the body 13 by a desired angular range θ_(t). As discussed,θ_(t) is larger than θ_(c). In some embodiments, the gear system may beconfigured such that a movement by the actuator 15 will result in arelatively smaller rotation of the body 13 and of the surgical device14, for finer control of angular position. In such cases, θ_(t) is lessthan θ_(c). In some embodiments, θ_(t) and θ_(c) may be governed by therelationship: θ_(t)=kθ_(c), wherein k represents an amplification factorwhen k>1, and represents a reduction factor when <1. In some cases, k isa constant that is based on the design of the gear system.

It should be noted that the handle 11 should not be limited to theexamples described previously, and that the handle 11 may have differentconfigurations in different embodiments. For example, in otherembodiments, the handle 11 may not include all of the features describedpreviously. Also, in other embodiments, the handle 11 may have othershapes and forms. Furthermore, in any of the embodiments describedherein, in addition to the control (e.g., the actuator 15, the coupler404, the ring 600, the wheel(s) 700, or any combination of theforegoing) described, the handle 11 may further include additionalcontrol(s) for performing other functions. As used in thisspecification, the term “control” may refer to any of the components ofthe handle 11, or any combination of the components of the handle 11.

Also, it should be noted that the surgical device/tool 14 of thesurgical instrument 9 should not be limited to the examples describedabove, and that the surgical instrument 9 may include other tools 14 inother embodiments. For example, although the above embodiments have beendescribed with reference to the surgical device 14 being for clamping,cutting, and/or sealing vessel (e.g., saphenous vein, an artery, or anyother vessel), in other embodiments, the surgical device 14 may be anyhave different configurations, and different functionalities. Forexample, in other embodiments, the surgical device 14 may be clipappliers or grasping jaws for grasping other types of tissues.

The cleaning system 160 for cleaning the lens of the endoscope 150 willnow be described with reference to FIGS. 16-21. For clarity purpose, thesurgical device 14 and the retractor 130 are omitted in these figures.

FIGS. 16A and 16B illustrate the cleaning system 160 that includes atubular structure 800 in accordance with some embodiments. As shown inFIG. 17, the tubular structure 800 has a distal end 801, a proximal end802, and a body 803 extending between the ends 801, 802. The tubularstructure 800 also has a first channel 804 that extends along the lengthof the tubular structure 800, and a second channel 806 that forms anangle with the first channel 804. In the illustrated embodiments, theangle may be a value that is between 20° and 40°, such as 30°. In otherembodiments, the angle may be other values, as long as the fluid can bedelivered to the lens of the endoscope 150. The second channel 806 is influid communication with the first channel 804, and ends with an opening808 that is located at an exterior surface of the tubular structure 800.The tubular structure 800 also includes a protrusion 810 that isconfigured to mate with a slot at the tube 20 (FIG. 16A). In otherembodiments, the protrusion 810 is optional, and the tubular structure800 may not include the protrusion 810. The tubular structure 800 may besecured to the tube 20 via an adhesive. In further embodiments, thestructure 800 and the distal portion of the tube 20 may be integrallyformed by a molding process to have a unity configuration.

As shown in FIG. 16B, the cleaning system 160 is located at a radialangle relative to the lens of the endoscope 150 such that the cleaningsystem 160 is not directly across from the endoscope 150. Suchconfiguration allows the tool 14 to be directly across the endoscope 150without having the cleaning system 160 interfering with the tool 14.Also, such configuration allows the opening 808 to be aimed at the lensof the endoscope 150 such that the fluid injection path does notintercept the tool 14 and the support structures 116 a, 116 b of theretractor 130. In other embodiments, the cleaning system 160 may bedirectly across from the endoscope 150. In such cases, the tool 14 maybe located at a radial angle relative to the endoscope 150 such that itis not directly across from the endoscope 150. Thus, in otherembodiments, the cleaning system 160 may be located at any positionrelative to the endoscope 150 (e.g., the cleaning system 160 may beimplemented at any location along the circumferential cross section ofthe tube 20). Also, in other embodiments, the cleaning system 160 may beconfigured so that the opening 808 is pointed towards other directions(e.g., for providing cleaning function at other target sites).

FIG. 18 illustrates a partial side view of the distal end of the tube 20in accordance with some embodiments. As shown in the figure, theproximal end 802 of the tubular structure 800 is coupled to a fluiddelivery tube 826. During use, the proximal end of the fluid deliverytube 826 is connected to a fluid source, such as a syringe. If the userdetermines that the lens of the endoscope 150 needs to be cleaned, theuser may operate on the syringe to cause fluid (e.g., saline, water,etc.) to be delivered from the syringe to the tubular structure 800 viathe tube 826. The fluid is delivered through the channel 804 and thechannel 806, and out of the opening 808. As shown in the figure, thesecond channel 806 is oriented such that fluid exiting from the opening808 is directed proximally towards the lens of the endoscope 150,thereby cleaning the lens of the endoscope 150.

It should be noted that the cleaning system 160 should not be limited tothe example described previously, and that the cleaning system 160 mayhave other configurations in other embodiments. For example, in otherembodiments, the cleaning system 160 may include a tubular structure 800that is in a form of a bent tube (FIG. 19). In other embodiments,instead of having a tubular structure coupled to the fluid delivery tube826, the cleaning system 160 may include just the fluid delivery tube826 having a bent distal end (FIG. 20). The fluid delivery tube 826 maybe secured to the tube 20 using an adhesive or a mechanical coupler. Inany of the embodiments described herein, the tube 20 may include adistal section that is mechanically attached (e.g., via an adhesive or amechanical coupler) to a remaining part of the tube 20. In such cases,the cleaning system 160 may be coupled to the distal section of the tube20.

In further embodiments, the cleaning system 160 may be implemented byproviding fluid delivery channels 840, 842 within the wall of the tube20 (FIG. 21). In such cases, the interior surface of the wall of thetube 20 will include an opening 844 for allowing fluid to be exitingtherethrough. In some embodiments, the tube 20 may include a distalsection that is mechanically attached (e.g., via an adhesive or amechanical coupler) to a remaining part of the tube 20. In such cases,the cleaning system 160 may be implemented at the distal section of thetube 20.

Also, as shown in the above embodiments, the distal end of the tube 20does not have any wall near the location where the endoscope 150 islocated. In particular, the tube 20 has a cut-out section 888 at thedistal end next to the endoscope 150, which allows fluid from thecleaning system 160 to escape without being trapped inside the tube 20(wherein trapped fluid may obstruct the view of the endoscope). The tube20 with the cut-out section may be formed by removing a section of atube that is used to construct the tube 20. Alternatively, the tube 20with the cut-out section may be formed by molding the tube 20 to havethe configuration shown. In other embodiments, the distal end of thetube 20 does not have the cut-out section.

In some embodiments, the distal end of the tube 20 may be a separatecomponent that is separately formed from a remaining part of the tube20, and is then coupled to the remaining part of the tube 20. Forexample, the distal end of the tube 20 may be molded to have an unityconfiguration. In some cases, such distal end of the tube 20 may bemolded to have the cut-out section 888, and the fluid delivery channels840, 842 (such as those shown in FIG. 21). One technique for forming thechannel 842 at the distal component 889 of the tube 20 is to place a pin890 relative to the material of the distal component 889 like that shownin FIG. 22. The pin 890 may be longer and may have a bent configurationso that it can also be used to form the channel 840. Such technique mayresult in the distal component 889 having an opening 892 through thewall of the component 889. Such opening 892 may be used to drain fluidduring use. For example, in some cases, cleaning fluid that is deliveredfrom the opening 844 may escape through the cut-out section 888 andthrough the opening 892.

Also, in any of the embodiments described herein, instead of using thecleaning system 160 to clean the lens of the endoscope, the cleaningsystem 160 may be used to clean other devices, such as another imagingdevice, a window of a component that is used to house an endoscope oranother type of imaging device, or other surgical tools.

It should be noted that the distal end 20/889 of the surgical instrumentis not limited to the configurations described previously, and that thedistal end 20/889 of the surgical instrument may have otherconfigurations in other embodiments. For example, in other embodiments,instead of the configuration shown in FIGS. 16-17, the distal end of thetube 20/component 889 may have the configuration shown in FIGS. 23 and24. Also, in other embodiments, instead of the configuration shown inFIG. 21, the distal end of the tube 20/component 889 may have theconfiguration shown in FIG. 25.

Although particular embodiments have been shown and described, it willbe understood that they are not intended to limit the presentinventions, and it will be obvious to those skilled in the art thatvarious changes and modifications may be made without departing from thespirit and scope of the present inventions. The specification anddrawings are, accordingly, to be regarded in an illustrative rather thanrestrictive sense. The present inventions are intended to coveralternatives, modifications, and equivalents, which may be includedwithin the spirit and scope of the present inventions as defined by theclaims.

What is claimed:
 1. An apparatus, comprising: a first tubular structurehaving a proximal end, a distal end, and a body extending between theproximal and distal ends, wherein the body includes a lumen for housingat least a part of an imaging device, wherein the first tubularstructure is configured for attachment to a distal end of a secondtubular structure, wherein the distal end of the first tubular structureincludes a first opening through an outer wall of the first tubularstructure, wherein the first opening is configured to drain fluid froman interior of the first tubular structure to an exterior of the firsttubular structure; a retractor that is slidable relative to the lumen; afluid delivery channel that is fixed in position relative to the body;and a second opening that is in fluid communication with the fluiddelivery channel; wherein the fluid delivery channel has a firstportion, and a second portion that forms an angle with an axis of thefirst portion; and wherein the first opening through the outer wall ofthe first tubular structure and the second portion of the fluid deliverychannel are aligned in a straight line and are separated by the interiorof the first tubular structure.
 2. The apparatus of claim 1, wherein theretractor is configured to engage with a vessel.
 3. The apparatus ofclaim 1, wherein the second tubular structure is a part of a vesselharvesting device.
 4. The apparatus of claim 1, wherein the secondopening is for delivering fluid towards the lumen where the imagingdevice is or will be located.
 5. The apparatus of claim 1, wherein thedistal end of the first tubular structure has a cut-out section.
 6. Theapparatus of claim 1, wherein the first tubular structure is integrallyformed to include the fluid delivery channel and the second opening,wherein the second opening is located on an interior surface of thefirst tubular structure.
 7. The apparatus of claim 6, wherein the distalend of the first tubular structure has a cut-out section.
 8. Theapparatus of claim 7, wherein the first opening is adjacent to thecut-out section.
 9. An apparatus, comprising: a first tubular structurehaving a proximal end, a distal end, and a body extending between theproximal and distal ends, wherein the body includes a lumen for housingat least a part of an imaging device, wherein the first tubularstructure is configured for attachment to a distal end of a secondtubular structure, wherein the distal end of the first tubular structureincludes a first opening through an outer wall of the first tubularstructure, wherein the first opening is configured to drain fluid froman interior of the first tubular structure to an exterior of the firsttubular structure; a fluid delivery channel that is fixed in positionrelative to the body; a second opening that is in fluid communicationwith the fluid delivery channel; and a first tissue manipulator and asecond tissue manipulator that are at least partially housed within thefirst tubular structure, wherein the first and second tissuemanipulators are not in a way of a fluid path that extends from thesecond opening; wherein the fluid delivery channel has a first portion,and a second portion that forms an angle with an axis of the firstportion; and wherein the first opening through the outer wall of thefirst tubular structure and the second portion of the fluid deliverychannel are aligned in a straight line and are separated by the interiorof the first tubular structure.
 10. The apparatus of claim 9, whereinthe first tissue manipulator comprises a device for cutting tissue, andthe second tissue manipulator comprises a retractor.
 11. The apparatusof claim 10, wherein the device for cutting tissue comprises a first jawand a second jaw.
 12. The apparatus of claim 11, wherein the first jawcomprises an electrically insulating material extending along a lengthof the first jaw, the electrically insulating material forming a lateralprotrusion on the first jaw, the lateral protrusion configured forabutting and positioning a main vessel away from a portion of anadjoining branch vessel grasped between the first and second jaws. 13.The apparatus of claim 11, wherein each of the first and second jawscomprise an electrically insulating material extending along a length ofeach of the first and second jaws, the electrically insulating materialforming on each of the first and second jaws a lateral protrusion, thelateral protrusions configured for abutting and positioning a mainvessel away from a portion of an adjoining branch vessel grasped betweenthe first and second jaws.
 14. The apparatus of claim 9, wherein thelumen, the first tissue manipulator, and the second tissue manipulatorare aligned in a straight line.
 15. The apparatus of claim 9, whereinthe first tubular structure is integrally formed to include the fluiddelivery channel and the second opening, wherein the second opening islocated on an interior surface of the first tubular structure.
 16. Theapparatus of claim 15, wherein the distal end of the first tubularstructure has a cut-out section.
 17. The apparatus of claim 16, whereinthe first opening is adjacent to the cut-out section.
 18. The apparatusof claim 15, wherein the first tissue manipulator comprises a device forcutting tissue, and the second tissue manipulator comprises a retractor,wherein the device for cutting tissue comprises a first jaw and a secondjaw.
 19. The apparatus of claim 18, wherein the first jaw comprises anelectrically insulating material extending along a length of the firstjaw, the electrically insulating material forming a lateral protrusionon the first jaw, the lateral protrusion configured for abutting andpositioning a main vessel away from a portion of an adjoining branchvessel grasped between the first and second jaws.
 20. The apparatus ofclaim 18, wherein each of the first and second jaws comprise anelectrically insulating material extending along a length of each of thefirst and second jaws, the electrically insulating material forming oneach of the first and second jaws a lateral protrusion, the lateralprotrusions configured for abutting and positioning a main vessel awayfrom a portion of an adjoining branch vessel grasped between the firstand second jaws.